Thailand needs more investment in health

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Thailand needs to invest more in public health in ways that bring handsome returns to the economy, health experts say.

“Investment in health today will reduce health risks in the future,” said Natt Hongdilokkul, a postdoctoral fellow at the British Columbia Centre for Excellence in HIV/Aids.

Speaking at a Bangkok seminar last month marking International Universal Health Coverage Day, Natt called Thai universal health coverage (UHC) a good example of investment in health that benefited both society and the economy.

Currently, 99.9 per cent of citizens are covered under universal healthcare, Social Security or Civil Servant Welfare.

Since its introduction in 2002, the tax-funded UHC has given more than 48.5 million Thais access to medical care. It has prevented deaths and eased expenditures. One study found that it reduced infant mortality by 13 to 30 per cent and out-of-pocket expenditures by 28 per cent for the average citizen.

Natt’s recent research on economic value generated by UHC indicates that the scheme also enabled people to spend more on non-medical consumption such as food, gas, groceries and entertainment. And it has increased life expectancy by a fraction (0.14) of a year, he discovered. UHC returns Bt1.73 on every baht the government spends on healthcare, Natt learned, two-thirds of that from the longer life expectancy.

“Public spending on the UHC is a health investment that’s paying off,” he said.

Countries around the world are seeing the advantages of investing in vaccine distribution, public awareness and disease prevention.

Tomohiko Makino, chief adviser to the Japan International Cooperation Agency’s Partnership Project for Global Health and UHC, said his government’s investments in health have increased “social capital for economic growth”.

Japan introduced UHC in 1961, resulting in rising productivity among a healthier workforce and thus a greater contribution to the economy. The medical industry has grown in turn, he said, particularly in pharmaceutical exports and technology.

Makino said the Japanese government had implemented “global health diplomacy”, engaging with other countries including Thailand in the development of health programmes.

Another clear benefit is seen in global funding for HIV and Aids programmes, which has led to fewer infections and increased access to anti-retroviral drugs.

According to the United Nations Programme on HIV and Aids (UNAids), low- and middle-income countries spent in excess of US$20 billion (Bt656 billion) on combating HIV and Aids in 2017, up from $10 billion in 2006.

The financing came from domestic public and private funds, international donors and the Global Fund to Fight Aids, Tuberculosis and Malaria, among other sources.

Recent years have seen a shift from reliance on overseas donors to internal financing. Thailand, for example, devotes a portion of “sin taxes” collected on alcohol and tobacco to healthcare, including HIV/Aids-prevention campaigns run by civil society. UHC covers the cost of anti-retroviral drugs, allowing people living with the disease to continue working and contributing to society.

Years of investment have reduced new HIV infections by 47 per cent since the virus was first detected in Thailand in 1996. Aids-related deaths have dropped by more than 51 per cent since the peak in 2004, according to UNAids.

The investment also helps generate information and data that improve the accuracy of epidemiology analysis.

“These are a few examples outlining how investment, particularly in Aids, has increased the ability of the health system to produce better health and non-health outcomes,” said Reeta Bhatia, senior policy adviser at UNAids. “Investing in Aids has contributed to health outcomes and to economic growth.

“Though much has been achieved, progress around the world has been uneven. Many countries like Thailand have made significant progress, including increasing the balance between the treatment and prevention of HIV, but we have other countries that are still far behind.”

It’s estimated that around 25 per cent of people globally do not even realise they are living with HIV, Bhatia said.

“The gaps we see have to do with more than investment and resources. They stem from structural barriers like stigma and discrimination, and the lack of political will to ensure that no one will be left behind. So it’s not always only about money.”

The research paper “Health Human Capital and Economic Growth in Sub-Saharan African and OECD Countries” by Kwabena Gyimah-Brempong and Mark Wilson indicated that sound investment in public health led to a 22-per-cent rise in per-capita income in Sub-Saharan Africa. The figure was 30 per cent in member-nations of the Organisation for Economic Cooperation and Development. Other research has linked improvements in public health to rises in gross domestic product (GDP).

Udomsak Saengow of Walailak University’s Centre of Excellence in Health Systems and Medical Research has been studying the connection between health access and income levels among UHC beneficiaries.

His team tracked hundreds of thousands of unemployed people and informal workers from 2001 – the year before UHC was introduced – and 2013, the first year the system was considered stable.

Improvement in health was evident, but it is not yet clear whether the subjects’ better health was linked to higher wages. “When people are healthy, we can assume their productivity will increase and result in a better income. But the income levels among our survey groups was lower than expected,” Dr Udomsak said.

“It’s a reality that people who work hard often earn less than others who sit still. This goes back to the inequality problem that plagues our society.”